Two things motivate me to expand on the idea that fixing medical care is the key to our financial woes. One is that despite all my words, even some of my blog correspondents do not understand the central concept of what aspect of medical care needs fixing, and the second, which dovetails nicely, is an editorial in
today’s Globe by Morton Kondracke, a national columnist who has become my favorite in the current bunch. Mr. Kondracke discusses how the Congressional GOP firebrands in Congress are planning to cut many essential programs in their Tea-party-inspired zeal to fix the nation’s fiscal woes. Included in their plans are cuts in essential science and medical programs known for having exceptional leverage. Among other things the GOP wants to cut research, which amounts to only 0.04 percent (that’s a multiplier of 0.004) of all government spending. It is much like taking an obese patient and trying to reduce his weight by slicing out some muscle!
Here’s the deal. Before the Tea Party destroys our governmental infrastructure, including the medical parts which are among the best-working, we need to fix the the greatest threat to our financial stability, and that is, as I have posted previously, medical-care costs. I submit that America has all the pieces needed for the world’s best medical system. We have centers of excellence, brilliant innovators, effective government regulation such as the NLM, CDC, PHS and NIH, the Mayo Clinics, and so on, but the pieces are bundled like Frankenstein’s monster in an incredibly inefficient paperwork bureaucracy and, most-important, a system design which lacks an essential ingredient: capitalism.
That’s right, capitalism is why our economic system, awkward as it is, trumps Communism. At least for small companies, the entrepreneur sinks or swims on his own in a free-for-all with his competitors and, just like in evolution, the fittest survive. Controlling costs is key to such success, but that factor is lacking in the current system for that majority who are covered by insurance. A patient who is covered by insurance has no incentive to ask the key questions. How much does the test/medicine/procedure/operation cost? Do I need a second opinion? Are there alternatives to pills/procedures? Would life-style changes make medicine or procedures unnecessary?
It is my opinion after 74 years of life on this planet that the majority of visits to doctors are unnecessary. It is just human nature to want to fix health problems with magic pills or by asking an expert (read, doctor) to fix them for us, when the real answer is to change our behavior.
Our life spans are largely determined by our genes. Each of our genes has so-called “junk DNA” on their ends, and these ends are slowly lost over time. When the ends are gone, we die. Therefore, each of us has a built-in life span (and I’m glad I don’t know mine), and it is ours to have and ours to diminish depending on the environmental treatment we give it. By that I mean smoking, excessive drinking, drug abuse, excessive stress (including lack of sleep), lack of exercise and poor nutrition (too much processed food and lack of portion-control). And the latter of course results in obesity, which leads naturally to heart disease and diabetes.
All these things are under our control without going to the doctor. We don’t need to go to the doctor for colds, or for obesity either for that matter. Colds last two weeks but can be limited to about 14 days with treatment. Antibiotics don’t work on viruses. We also get little or no real value from most over-the-counter medicines, including the pseudoephedrine that are so much in the news. Most such “remedies” work through the placebo effect.
One of the most-prescribed kinds of medicines of all, and one of the more-expensive too, is statins. If we exercise and eat right, most of the need for statins would disappear, along with a big chunk of medical costs.
What’s left for doctors to treat? I’m not a doctor, but as I said, I’ve got experience. Off the top of my head, appendicitis, tetanus, gaul or kidney stones, rare diseases, broken bones, cancer from genetic weaknesses (including allergies) or environmental toxins, and general genetically-caused problems. I believe that most doctors, if they are candid, will agree that these are small in number compared what patients could deal with themselves, if they only would.
So there is the challenge. If people were incentivized to care about medical costs, might they step up their own responsibility for their own health? It won’t be easy because we are talking about human nature here, but unless we provide people with an incentive to be proactive about their health, there is ZERO chance of fixing the system. Such a change will take leadership, but all the leadership in the world won’t work unless people are incentivized to listen. Having the patient pay at least part of her doctor’s bill is that incentive. If the poor need help in paying, fine, give them help. But everyone, and I mean everyone, needs to pay something out of their own pocket!
Now open wide, America, and take your medicine. This is your Dutch uncle talking. Get a good night’s sleep and you’ll feel better in the morning. Tomorrow we exercise. And Tea-partiers? Wake up, you meat-heads! You’re cutting into our muscle!